Anatomy/Symptoms
Carpal tunnel syndrome is a common problem. It is caused by pressure on the median nerve that runs within the carpal tunnel. The carpal tunnel is a natural structure that is formed between the transverse carpal ligament and the bones of the wrist (carpals).
The median nerve and nine tendons run from the forearm, through the tunnel and into the hand. The nerve provides sensation to the thumb, index, middle and half the ring finger and the muscles of the thumb. The ulna nerve supplies sensation to the little finger and the other half of the ring finger.
It is not fully understood how or why carpal tunnel syndrome develops. In general, it is the result of inflammation of the tendons and tissues exerting pressure on the median nerve. This causes pain, numbness, weakness and tingling sensations in the hand and fingers. The pain and weakness may also occur in the arm.
These symptoms can occur with activity and at night, when resting.
Non-Operative Treatment
To help prevent further damage from carpal tunnel syndrome, conservative treatment such as steroid injections (to reduce inflammation) and the use of wrist supports may help.
If these methods fail and the symptoms of carpal tunnel syndrome are disabling, surgery may be indicated.
Operative Treatment - Carpal Tunnel Decompression
Traditionally, carpal tunnel decompression has been performed as an ‘open’ procedure. This involves an incision about 5cm long on the palm of the hand. The carpal ligament is then cut, freeing the median nerve lying beneath it.
More recently, an endoscopic approach to carpal tunnel decompression has developed. This involves the use of a small telescope and specialised instruments to cut the ligament free from the nerve within the tunnel. Two very small incisions (about 1cm long) are made to perform the surgery. This minimally invasive approach to surgery also allows for both hands to be treated simultaneously if required. I have been performing endoscopic carpal tunnel decompressions since 1991. Both methods achieve the same result of releasing the pressure on the median nerve.
Post-Operative Course
The main advantages of performing this surgery endoscopically are smaller surgical wounds, less post-operative pain, a faster return to normal activities and fewer long term complications
The day after surgery, bandaids or other waterproof dressings will be applied to the incision sites. A wrist support will also be applied.
Following the procedure, return of function is usually about 2-3 weeks. The wrist support should be worn for approximately 2 weeks, or as directed.
Risks/Complications
Possible complications of this surgery include: